Abstract: FR-PO1215
Everolimus-Based Regimens and Cytomegalovirus Infection Suppression in Kidney Transplantation: Meta-Analysis of Randomized Controlled Trials
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Cha, Joon Hyuk, Inha University Hospital, Incheon, Korea (the Republic of)
- Song, Joon Ho, Inha University Hospital, Incheon, Korea (the Republic of)
- Lee, Seoung woo, Inha University Hospital, Incheon, Korea (the Republic of)
- Hwang, Seon Deok, Inha University Hospital, Incheon, Korea (the Republic of)
Background
Cytomegalovirus (CMV) infection remains one of the most significant post-transplant complications, contributing to patient morbidity, graft dysfunction, and indirect immunologic injury. Everolimus (EVR), an mTOR inhibitor, exhibits both antiproliferative and antiviral properties that may reduce CMV incidence while permitting calcineurin inhibitor (CNI) minimization. This meta-analysis compared the efficacy, safety, and infection outcomes of EVR-based versus mycophenolate (MPA)-based immunosuppressive regimens in kidney transplant recipients.
Methods
A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen randomized controlled trials (n = 8,467) comparing EVR + CNI (± corticosteroid) and MPA + CNI were identified through MEDLINE, EMBASE, and the Cochrane Library. The primary endpoints were biopsy-proven acute rejection (BPAR), mortality, renal function (eGFR), and infection outcomes including CMV infection. Pooled risk ratios (RRs) and mean differences (MDs) were calculated using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was evaluated by the I^2 statistic, and publication bias by funnel-plot and Egger’s test.
Results
Across all studies, EVR-based therapy showed comparable efficacy to MPA-based regimens for BPAR (pooled RR 1.09, 95% CI 0.89–1.34, P = 0.38) and mortality (RR 0.85, 95% CI 0.63–1.16). Mean eGFR at follow-up was similar between groups (MD +0.9 mL/min, 95% CI –2.2 to +4.1). The overall risk of infection was significantly reduced with EVR-based therapy (RR 0.83, 95% CI 0.73–0.93, P < 0.01). When restricted to CMV events, the pooled RR was 0.54 (95% CI 0.36–0.81, P = 0.003), favoring EVR and confirming a consistent antiviral effect across de novo and maintenance cohorts. No significant difference was observed in graft loss or treatment discontinuation.
Conclusion
Everolimus combined with low-dose CNI provides similar graft and patient survival outcomes compared with MPA-based therapy, while conferring a clear advantage in infection control, particularly in reducing CMV infection. These findings support EVR-based regimens as an effective, infection-conscious alternative for long-term immunosuppression in kidney transplantation.